Comorbidity, Radiation Duration, and Pretreatment Body Muscle Mass Predict Early Treatment Failure in Taiwanese Patients with Locally Advanced Oral Cavity Squamous Cell Carcinoma after Completion of Adjuvant Concurrent Chemoradiotherapy.

Yu-Ching Lin,Yi-Ping Pan,Kun-Yun Yeh,Wen-Chi Chou,Pei-Hung Chang,Hang Huong Ling,Cheng-Hsu Wang,Fang-Ping Chen

doi:10.3390/diagnostics11071203

Abstract

Few prospective cohort trials have evaluated the potential risk factors of early treatment failure of locally advanced oral cavity squamous cell carcinoma (LAOCSCC) patients following the completion of postoperative adjuvant concurrent chemoradiotherapy (CCRT). We collected clinicopathological variables, nutrition-inflammatory markers and total body composition data assessed by dual-energy X-ray absorptiometry (DXA) before and after CCRT. A factor analysis was used to reduce the number of DXA-derived parameters. Cox proportional hazard models were applied to determine the risk factors associated with early treatment failure defined as tumor progression or death within 180 days of CCRT completion. A total of 69 patients were eligible for analysis. After CCRT, the body weight, body mass index, nutritional markers, and muscle mass decreased, whereas C-reactive protein level increased. Five factors reflecting different body composition statuses were identified. A total of 21 patients (30.4%) developed early treatment failure. Comorbidities (hazard ratio ((HR)), 2.699; 95% confidence interval ((CI)), 1.005–7.913; p = 0.044), radiation duration (HR, 1.092; 95% CI, 1.015–1.174; p = 0.018) and the pretreatment body muscle mass (HR, 0.578; 95% CI, 0.345–0.957; p = 0.037) independently contributed to early treatment failure. Comorbidities, longer radiation duration, and lower pretreatment body muscle mass are predictive factors for early treatment failure in LAOCSCC patients following postoperative adjuvant CCRT completion.

Highlights

Concurrent chemoradiotherapy (CCRT) is the main treatment modality for patients with locally advanced head and neck cancer (LAHNC) following surgery as adjuvant therapy
Early treatment failure, which occurs within a short period after CCRT completion, is a serious complication that may occur despite patients receiving adequate supportive care during CCRT [6,7]
A total of 86 patients with locally advanced OCSCC were recruited, 69 of whom were eligible for analysis in this study

Summary

Introduction

Concurrent chemoradiotherapy (CCRT) is the main treatment modality for patients with locally advanced head and neck cancer (LAHNC) following surgery as adjuvant therapy. Since the majority of patients with early tumor progression are asymptomatic, unaware of symptoms, or fail to bring it forward during their medical visits due to comorbidities, poor performance status, or fear of previous CCRT-associated adversities, a delayed detection of early treatment failure is commonly seen in the daily practice [8]. This delay may have profound implications for further treatment and longterm survival [8]. The prompt identification of the potential risk factors associated with ETF is urgently needed

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Results